Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
Complementary Alternative Cardiovascular Medicine
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110 <strong>Alternative</strong> <strong>Cardiovascular</strong> <strong>Medicine</strong><br />
incidence of death or CHF was 6% with carnitine vs 9.6% with placebo<br />
[p = ns]. L-carnitine has been also studied in post-myocardial infarction<br />
(MI) patients. Davini et al. (39) showed a significant decrease in mortality<br />
with carnitine (1.2% vs 12.5%, p < 0.005) at 1-yr follow-up. However,<br />
this was an open trial. Lack of blinding and higher number of<br />
hypertensive patients in the control arm may make the results unreliable.<br />
Carnitine also plays a protective role in patients with ischemic heart<br />
disease. Corbucci et al. (40) demonstrated the absence of ischemic<br />
changes in the carnitine group vs the control group in 120 patients undergoing<br />
extracorporeal circulation (ECC) during aortopulmonary bypass<br />
surgery. Levels of lactate, pyruvate, and succinate/fumarate ratio, reflective<br />
of glycolytic cellular metabolism, were measured before and after<br />
ECC. These levels remained in the normal range in patients with supplemental<br />
carnitine when compared to the placebo group.<br />
Several small, uncontrolled studies have noted a lower systemic vascular<br />
resistance, an augmented ionotropic state, and enhanced lactate<br />
extraction as a consequence of carnitine treatment (36). If confirmed,<br />
these reported hemodynamic effects would suggest a role in CHF treatment.<br />
It is well documented that carnitine deficiency causes dilated cardiomyopathy,<br />
along with skeletal myopathy. In selected studies,<br />
supplementation has led to significant responses. Mancini et al. (41)<br />
studied 60 patients with CHF (EF < 50%, NYHA class II or III) for 180 d.<br />
Patients received 500 mg/3 times a day of PLC or placebo. The only other<br />
medications included digoxin and diuretics. There was significant improvement<br />
in exercise times (increased by 26%) and ejection fractions (increased<br />
by 14%). In an other larger study of 574 patients with heart failure and<br />
EF < 40%, exercise tolerance was significantly improved in the carnitine<br />
group when compared with placebo (42). However, the carnitine group<br />
demonstrated a slightly higher mortality (3.0% vs 1.9%) and a higher<br />
admission rate (6.3% vs 5.3%). Romagnoli et al. (43) studied the effects<br />
of L-carnitine in patients undergoing dialysis. Their observational study<br />
showed that L-carnitine addition to conventional therapy resulted in<br />
overall improved clinical status, with increased mean ejection fraction<br />
from 32% to 41.8 % (p < 0.05) and reduction in erythropoietin dosage.<br />
Carnitine supplementation has also been noted to reduce the levels of<br />
free FFA and triglycerides in clinical studies (44). However, the mechanism<br />
is not clear. Larger clinical trails are needed to verify the lipidlowering<br />
effects of carnitine.<br />
Lower carnitine levels have been found in the muscle biopsies of<br />
patients undergoing revascularization procedure for severe peripheral<br />
vascular disease (PVD). In a double-blind, placebo-controlled, dosetitration,<br />
multicenter trial, Brevetti et al. (45) have shown that active